How good is a living donor? Systematic review and meta-analysis of the effect of donor demographics on post kidney transplant outcomes.
Bellini MI., Nozdrin M., Pengel L., Knight S., Papalois V.
BACKGROUND AND AIMS: Living donor kidneys are considered the best quality organs. In the attempt to expand the donor pool, the donor's age, sex and body mass index (BMI) might be considered as potential determinants of the kidney transplant outcomes, and thus guide recipient selection. We aimed to investigate the effects of donor demographics on kidney function, graft and recipient survival, delayed graft function (DGF) and acute rejection (AR). METHODS: Systematic review and meta-analysis. EMBASE, MEDLINE, Web of Science, BIOSIS, CABI, SciELO and Cochrane were searched using algorithms. NHBLI tools were used for risk of bias assessment. Mean difference (MD), standardized mean difference (SMD), and risk ratio (RR) were calculated in Revman 5.4 RESULTS: Altogether, 5129 studies were identified by the search algorithm; 47 studies met the inclusion criteria and were analyzed. No significant difference in recipient 1-year survival was found between recipients of donors aged 50 (RR = 0.65 95% CI: 0.1-4.1), and recipients of donors aged 60 (RR = 0.81 95% CI: 0.3-2.3). Graft survival was significantly higher in recipients of grafts from donors aged 60 years (MD = 0.3 mg/dl 95% CI: 0.1-0.9), although there was high heterogeneity. Recipients of grafts from male donors had lower 1-year serum creatinine (MD = 0.12 mg/dl 95% CI: 0.2-0.1) and higher eGFR compared to recipients of female donors (p